Anterior segment optical coherence topography (AS-OCT) is a non-contact imaging modality that uses low-coherence interferometry to visualize the ocular anterior segment structures.
AS-OCT has demonstrated its ability in adults to accurately measure corneal thickness, epithelial thickness, angle opening distance (AOD), angle recess area (ARA), anterior chamber depth (ACD), and lens vault.
Hand-held OCT (HH-OCT) has emerged as a valuable tool in the diagnosis and management of various pediatric optic neuropathies.
A comprehensive literature search was performed in October 2024 across four major databases: PubMed, Web of Science, EBSCOhost, and Google Scholar.The objective was to identify original studies evaluating the clinical application of AS-OCT—including HH-AS-OCT—in the assessment of childhood glaucoma.
15 studies including 406 glaucomatous eyes with diverse etiologies such as primary congenital, juvenile open-angle, post-cataract, and syndromic glaucoma published between 2012 and 2025 were included in the review.
AS-OCT enabled high-resolution visualization of the trabecular meshwork, Schlemm canal, iris, and anterior chamber angle. Several studies proposed diagnostic thresholds for iris thickness and angle width, with area under the receiver operating characteristic curves ranging from 0.69 to 0.87. Postoperative imaging documented drainage device position and angle anatomy, while HH-AS-OCT facilitated imaging in infants and uncooperative children, revealing subclinical abnormalities undetectable by gonioscopy; however, these structural findings do not consistently predict clinical outcomes. Heterogeneity in devices, imaging protocols, and glaucoma phenotypes limits standardization, and no definitive AS-OCT biomarker has yet emerged in childhood glaucoma. [1]
In a study by Kaushik et al, no visibility of the trabecular meshwork structures was the most specific sign for glaucomatous eyes. [2]
Lever is of the opinion that the OCT measurements of the pRNFL and macular thickness have a strong ability to diagnose paediatric glaucoma. However, OCT should be used in addition to conventional diagnostic tools rather than as a standalone method. [3]
REFERENCES:
- Abdelaal A, Kawji A, Gad W, Alzein A, Chang TC, Bitrian E, El Sayed YM, Gawdat GI, Hassan AK, El-Fayoumi D, Elhusseiny AM. Utilization of anterior segment optical coherence tomography in childhood glaucoma: A systematic review. Surv Ophthalmol. 2026 Jun 27:S0039-6257(26)00086-X. doi: 10.1016/j.survophthal.2026.06.011. Epub ahead of print. PMID: 42364735.
- Kaushik S, Singh AK, Thattaruthody F, Suresh V, Gera A, Yadav S, Pandav SS. Utility of Swept-Source Anterior-Segment OCT as an In-Office Biomarker for Early Childhood Glaucoma. JAMA Ophthalmol. 2025 Jul 1;143(7):553-560. doi: 10.1001/jamaophthalmol.2025.1009. PMID: 40402480; PMCID: PMC12100509.
- Lever M, Halfwassen C, Unterlauft JD, Bechrakis NE, Manthey A, Böhm MRR. The Paediatric Glaucoma Diagnostic Ability of Optical Coherence Tomography: A Comparison of Macular Segmentation and Peripapillary Retinal Nerve Fibre Layer Thickness. Biology (Basel). 2021 Mar 25;10(4):260. doi: 10.3390/biology10040260. PMID: 33805903; PMCID: PMC8064387.
